Case of sodium–glucose cotransporter-2 inhibitor-associated euglycaemic diabetic ketoacidosis

Abstract

Following non-elective orthopaedic surgery, a 61-year-old man with poorly controlled type 2 diabetes mellitus on empagliflozin developed high anion gap metabolic acidosis in the high-dependency unit. Metabolic acidosis persisted despite intravenous sodium bicarbonate, contributing to tachycardia and a run of non-sustained ventricular tachycardia. He was euglycaemic throughout hospital admission. Investigations revealed elevated urine and capillary ketones, and a diagnosis of sodium–glucose cotransporter-2 inhibitor-associated euglycaemic diabetic ketoacidosis was made. He was treated with an intravenous sliding scale insulin infusion and concurrent dextrose 5% with potassium chloride. Within 24 hours of treatment, his arterial pH, anion gap and serum bicarbonate levels normalised. After a further 12 hours, the intravenous insulin infusion was converted to a basal/bolus regimen of subcutaneous insulin, and he was transferred to the general ward. He was discharged well on subcutaneous insulin 6 days postoperatively.

SGLT-2 inhibitor associated euglycaemic diabetic ketoacidosis in an orthopaedic trauma patient

“…The case literature describes two similar previous cases in orthopaedic trauma patients. One in a patient with L1 vertebral, left ulnar and right radius fractures8 and another in a patient with a femoral diaphyseal fracture 9. To our knowledge, this is the first case describing EuDKA associated with SGLT-2 inhibitor use in a patient undergoing surgical fixation of a hip fracture.…”

SGLT2 inhibitor associated euglycaemic diabetic ketoacidosis in an orthopaedic trauma patient

“…The case literature describes two similar previous cases in orthopaedic trauma patients. One in a patient with L1 vertebral, left ulnar and right radius fractures8 and another in a patient with a femoral diaphyseal fracture 9. To our knowledge, this is the first case describing EuDKA associated with SGLT2 inhibitor use in a patient undergoing surgical fixation of a hip fracture.…”